BACKGROUND Salvage radiation therapy (SRT) is a recommended treatment option for biochemical recurrence after radical prostatectomy (RP). However, its effectiveness may be limited to specific categories of patients. OBJECTIVE We aimed to identify the optimal candidates for early SRT after RP. DESIGN, SETTING, AND PARTICIPANTS The study included 925 node-negative patients treated with SRT after RP at seven institutions. Patients received SRT for either prostate-specific antigen (PSA) rising, or PSA persistence after RP that was defined as PSA level ≥0.1 ng/ml at 1 mo after surgery. All patients received local radiation to the prostate and seminal vesicle bed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome measured was distant metastasis after SRT. Regression tree analysis was used to develop a risk-stratification tool. Multivariable Cox regression analysis and nonparametric curve fitting methods were used to explore the relationship between PSA level at SRT and the probability of metastasis-free survival at 8 yr. RESULTS AND LIMITATIONS At a median follow-up of 8.0 yr, 130 patients developed distant metastasis. At multivariable analysis, pre-SRT PSA level was significantly associated with distant metastasis (hazard ratio: 1.06, p<0.0001). However, when patients were stratified into five risk groups using regression tree analysis (area under the curve: 85%), early SRT administration provided better metastasis-free survival in three groups only: (1) low risk: undetectable PSA after RP, Gleason score ≤7, and tumour stage ≥pT3b, (2) intermediate risk: undetectable PSA after RP with Gleason score ≥8, (3) high risk: PSA persistence after RP with Gleason score ≤7. CONCLUSIONS We developed an accurate risk stratification tool to facilitate the individualised recommendation for early SRT based on prostate cancer characteristics. Early SRT proved to be beneficial only in selected groups of patients who are more likely to be affected by clinically significant but not yet systemic recurrence at the time of salvage treatment administration. PATIENT SUMMARY In patients affected by prostate cancer recurrence after radical prostatectomy, the early administration of salvage radiation therapy is beneficial only for selected subgroups of patients. In this study, these groups of patients were identified.

中文翻译：

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早期挽救性放射治疗对根治性前列腺切除术后前列腺特异性抗原持续升高或升高的患者的影响。

背景 挽救性放射治疗 (SRT) 是根治性前列腺切除术 (RP) 后生化复发的推荐治疗选择。然而，其有效性可能仅限于特定类别的患者。目的 我们旨在确定 RP 后早期 SRT 的最佳候选者。设计、设置和参与者 该研究包括 925 名在 7 家机构进行 RP 后接受 SRT 治疗的淋巴结阴性患者。患者接受 SRT 治疗前列腺特异性抗原 (PSA) 升高或 RP 后 PSA 持续存在，定义为术后 1 个月 PSA 水平≥0.1 ng/ml。所有患者都接受了前列腺和精囊床的局部放射治疗。结果测量和统计分析 测量的主要结果是 SRT 后的远处转移。回归树分析用于开发风险分层工具。采用多变量 Cox 回归分析和非参数曲线拟合方法探讨 SRT 时 PSA 水平与 8 年无转移生存率之间的关系。结果和局限性 在中位随访 8 年时，130 名患者发生远处转移。在多变量分析中，SRT 前 PSA 水平与远处转移显着相关（风险比：1.06，p<0.0001）。然而，当使用回归树分析将患者分为五个风险组时（曲线下面积：85%），早期 SRT 给药仅在三个组中提供了更好的无转移生存期：（1）低风险：RP 后检测不到 PSA，Gleason评分≤7，肿瘤分期≥pT3b，（2）中度风险：RP 后无法检测到 PSA，Gleason 评分≥8，（3）高风险：RP 后 PSA 持续存在，Gleason 评分≤7。结论 我们开发了一种准确的风险分层工具，以促进基于前列腺癌特征的早期 SRT 的个体化推荐。早期 SRT 被证明仅对选定的患者组有益，这些患者在挽救治疗给药时更有可能受到临床显着但尚未全身复发的影响。患者总结 在根治性前列腺切除术后受前列腺癌复发影响的患者中，早期实施挽救性放射治疗仅对选定的患者亚组有益。在这项研究中，确定了这些患者组。早期 SRT 被证明仅对选定的患者组有益，这些患者在挽救治疗给药时更有可能受到临床显着但尚未全身复发的影响。患者总结 在根治性前列腺切除术后受前列腺癌复发影响的患者中，早期实施挽救性放射治疗仅对选定的患者亚组有益。在这项研究中，确定了这些患者组。早期 SRT 被证明仅对选定的患者组有益，这些患者在挽救治疗给药时更有可能受到临床显着但尚未全身复发的影响。患者总结 在根治性前列腺切除术后受前列腺癌复发影响的患者中，早期实施挽救性放射治疗仅对选定的患者亚组有益。在这项研究中，确定了这些患者组。